Radical Prostatectomy in High-Risk Prostate Cancer: Incidence of Specimen-Confined Disease (pT2-pT3a N0R0) and Outcomes. Issue 2 (April 2014)

• Record Type: Journal Article
• Authors: Mearini, Luigi; Nunzi, Elisabetta; Bini, Vittorio; Lepri, Luca; Bruno, Raffaella; Porena, Massimo
• Is Part Of: Urologia journal. Volume 81:Issue 2(2014)
• Page Start: 125
• Page End: 132
• Publication Date: 2014-04
• Subjects: Radical prostatectomy -- Specimen-confined disease -- High-risk prostate cancer -- Outcomes -- Prostatectomia radicale -- Malattia confinata al pezzo operatorio -- Tumore della prostata ad alto rischio -- Risultati; Urology -- Periodicals; 616.6005
• DOI: 10.5301/urologia.5000030
• Languages: English
• ISSNs: 0391-5603

Abstract

Introduction: Radical prostatectomy (RP) in patients with high-risk prostate cancer (PC) [prostate specific antigen (PSA) ≥20 ng/mL, and/or Gleason score ≥8, and/or cT3a disease] is considered an optional therapy, usually as a part of multimodal approach. Aim of the study is to evaluate the outcome of radical prostatectomy in case of specimen-confined (SC) disease and to compare it with patients with pathological locally-advanced disease. Materials and Methods: Data from 176 consecutive patients with high-risk prostate cancer who underwent RP as initial therapy were analyzed, identifying subjects with specimen-confined disease (i.e. negative margins and negative lymph-nodes) in which RP was considered as monotherapy, and comparing oncological outcomes to patients with pathological non-SC disease, in which RP was considered as the first step of a multimodal approach. Results: In high-risk prostate cancer, pathological report showed the presence of specimen-confined disease in 28.3% of cases. At univariate analysis, age and PSA correlate with the presence of SC disease at radical prostatectomy, while at multivariate analysis only PSA was a significant predictor of SC disease. At 5 years, Kaplan-Meier estimation of biochemical-free and cancer-specific survival was 56.2% and 97.7% vs 40.8% and 92.8% in specimen-confined disease and non-specimen-confined disease, respectively. Conclusions: High-risk prostate cancer presents challenges for uro-oncologists since standard treatment is still under debate. One third of patients will present with specimen-confined disease, for which radical prostatectomy represents the sole, initial curative therapy; RP as multimodal therapy in patients without SC disease permits excellent long-term oncological outcomes.